Letterkenny University Hospital has welcomed the publication by a HIQA report last week, which expressed concern at long wait times in the ED and also concerns at the delay in ambulance turnarounds. Hospital Manager Sean Murphy says significant progress has been made, and they are working hard to address the issues highlighted in the report.
During the inspection, HIQA looked at eleven National Standards.
Of these, Letterkenny University Hospital was substantially compliant in four, partially compliant in six, and fully compliant in one.
Sean Murphy says that, of the 20 recommendations contained in the LUH Bed Utilization survey, 13 are complete. and work is progressing on the other 7.
The hospital says it is continuing to recruit key personnel and progress is being made, particularly in the area of nursing.
Finally, the hospital is preparing to rolling out a new integrated patient management system, which will allow the hospital to work with other health services in the region, that is due to be launched in mid-May.
The HIQA can be read HERE
Hospital Response in full –
Media Statement
Letterkenny University Hospital welcomes publication of HIQA report following inspection
07 May 2024
Letterkenny University Hospital welcomes the publication by Health Information Quality Authority (HIQA) of its report into its inspection of three areas at Letterkenny University Hospital (LUH). An un-announced inspection was carried out at the hospital on the 7th and 8th of November 2023
The areas assessed were the Emergency Department, Surgical Ward 2 and Medical Ward 3.
The focus of the inspection was to monitor the hospital’s compliance with the National Standards for Safer Better Healthcare. It was also used to assess progress on implementation of the hospital’s compliance plan relating to the HIQA two-day announced inspection, conducted in November 2022.
HIQA’s core assessment focused on key standards relating to leadership, governance and management, workforce, person-centred care, safe care and support and effective care.
During this inspection, HIQA looked at eleven National Standards, of these, Letterkenny University Hospital was substantially compliant in four standards, partially compliant in six standards, and fully compliant in one standard.
Sean Murphy Hospital Manager at Letterkenny University Hospital said, “We welcome this report and recognise the important and valuable role of HIQA in promoting safety and quality in healthcare services.
Significant progress has been made in a number of key areas since the previous HIQA inspection in 2022 including; increased staffing, enhanced governance, improved staff engagement and improved systems and processes to support patient flow through the emergency department.
We are working hard to address the issues highlighted in this report and acknowledge the ongoing commitment of our staff who provide excellent person-centred care in our very busy hospital.
I would like to commend our staff for their kindness and compassion in treating patients which was noted extensively throughout in the report. It is also encouraging to note that our commitment to listening, engaging and responding to staff feedback via our Change Plan process has been cited as a very positive action by HIQA.
With all our staff focused on improving the quality and safety of our services we will build on the good practice highlighted in this report.”
In response to the recommendations in the HIQA report and as part of our ongoing focus on improving quality and safety and governance in the hospital we have undertaken the following measures:
A number of actions have recently been implemented in the hospital and in the community to further enhance the patient flow.
Key outputs include;
Promotion and communication of Governance, Roles, Responsibilities and Daily Flow Operations
Increasing awareness among all clinical teams of discharge planning and home by 11
Implemented processes around Delayed Transfer of Care including communication with Patients and family members
Implementation of Thursday and Friday Clinical and Discharge Meetings
Reviewed processes for urgent radiology reporting for GP Diagnostics and implemented defined processes
Reviewed and updated Community Nursing Unit Admission Policy.
Implemented weekly team meeting to track and monitor actions against completion plan and KPIs; discuss and agree countermeasures to keep improvement on track
Of the 20 recommendations contained in the LUH Bed Utilization survey, 13 recommendations are complete. These measures related to; discharge planning, patient flow, home by 11 initiative, enhanced reporting and escalation procedures with visual tracking information updated every 2 hours, and expansion of the Safety Flow Huddle to include additional departments and data.
Seven recommendations from the survey are ongoing, these include the development of a specialty based ward cohorting plan which is scheduled for completion in June 2024, and ongoing training and engagement with Consultants and Non Consultant Hospital Doctors to ensure delivery of Predicted Dates of Discharge for all inpatients.
We welcome the report’s findings about our improvement in nurse recruitment. Our staff nurse WTE allocation is 572, with only 4 vacancies currently this represents a significant improvement on the previous inspection when 35 nursing posts were unfilled.
Six of our seven Consultant Radiologists in LUH are on the Specialist Register for Radiology. These posts have been filled on a medium term basis as an interim measure until recruitment for permanent posting has concluded. Three of our Consultant Radiologists hold permanent HSE contracts and four are on fixed term contracts.
LUH has approval for 8.0 WTE Emergency Medicine Consultants. There are currently 5 Consultants in Emergency Medicine holding permanent contracts, with five other consultants holding fixed term contracts. Six of these consultants are on the specialist register of the Irish Medical Council, however one of them is currently on long term leave.
LUH is continuing in its efforts to recruit to fill all consultant posts with permanent candidates recruited through the Public Appointment Service which is the only avenue available for the permanent appointment of Consultant posts in public hospitals throughout the Republic of Ireland.
The report cities concerns about the impact of staff shortages in the Pharmacy Department on the delivery of clinical pharmacy services and we are pleased to report that as a result of a number of recent successful recruitment campaigns, we have filled a number of long-standing vacancies across Pharmacy services, including clinical pharmacy service provision.
Clinical pharmacy services are now being provided to every medical ward in LUH as well as filling speciality posts in specialist areas.
Due to resignations and leave, we have a number of unfilled vacancies currently but continue to resource our Dispensary to address medication queries from all other areas of the hospital as we focus on recruitment of these vacancies.
Since the inspection the Patient Advice and Liaison Service (PALS) has recommenced in LUH and the PALS officer is providing support to patients and helping to manage their complaints. There is a vacancy for one additional PALS officer which are trying to fill, the HSE embargo on recruitment impacts the options to fill this post.
The report has cited a backlog of complaints which fall outside of the 30 day KPI, we are working very hard to resolve this backlog. This work is being monitored on the Complaints Management System and reported to the Quality and Patient Safety Committee and the Hospital Management Team. There are currently significant staff vacancies in the Consumer Services Department due to retirement and long term sick leave. We have been unable to recruit into these posts due to the HSE recruitment freeze.
However, the Quality and Patient Safety Manager is providing limited cover in addition to her role and has made contact with all the complainants that are awaiting responses. The historical backlog has been addressed and we are currently developing a standard operating procedure to improve KPI compliance to make it more contemporary and user friendly. We have also developed a guideline for clinicians to ensure a good standard of response is given for matters of clinical judgement.
To improve patient engagement and to empower and engage with patients to improve safety, the Quality and Patient Safety Department launched the Quality and Patient Safety bedside poster in September 2023. There is significant signage erected throughout the hospital site in relation to how patients can make a complaint.
The hospital has also launched a Patient and Family Experience are using the learnings from the lived experience of patients to improve our services.
In relation to compliance with CPE admission testing, Quality Improvement Projects to address non-compliance with CPE admission screening remains in place for some wards but overall hospital compliance has increased to 91% Q3 23, 88% Q4 23 and 90% Q1 24.
In relation to the report’s recommendation regarding audit of compliance of clinical handover, the Clinical Handover Policy at the hospital has been reviewed and updated.
The new Clinical Handover Policy has recently been approved by the LUH Hospital Management Team and is currently in the process of implementation.
An audit tool has been developed and forms part of the implementation. It is planned to audit this policy in September 2024. We are currently rolling out the National Healthcare Communication Programme which includes training on effective clinical handover.
LUH are near completion of the roll-out of an important new ICT system called IPMS (Integrated Patient Management System). The system will enable integration with other health services in the region, will improve the way we communicate with patients and will allow for better informed clinical decision making.
All patient touch points within our services will be recorded in the new system such as ED attendances, inpatient attendances and outpatient attendances.
IPMS tracks and captures the patient journey throughout their interactions with the acute hospital service
Staff are currently undergoing training on the new system with a view to launching in mid-May.
